This is the second of a 3-part case against physician-assisted suicide. It is reprinted from a presentation made to the Blackstone Fellowship of Alliance Defending Freedom on June 12, 2018, by pro-life apologist Scott Klusendorf. Used by permission. Please refer to the case study and help from theology in part 1 and watch for the upcoming Part 3: Help from Pastoral Care.
HELP FROM ETHICS
- With the dying patient, it comes down to intent. Are we withdrawing treatment because we intend to kill the patient or because it no longer benefits him in the final stages of dying?
Agneta Sutton makes a great point: A truly medical (as opposed to quality of life) decision to withdraw treatment is based on the belief that the treatment is valueless (futile), not that the patient is so. So, while doctors are indeed qualified to determine if a treatment is futile, they are no more qualified than anyone else to determine that an individual life is futile.
In Gregg’s case, food and water should only be withdrawn in the final stages when they no longer benefit him and will only cause additional suffering. On this understanding, the withdrawing of treatment is not intended to kill, only to avoid prolonged and excessive agony for the patient. True, death will come, but it comes as the result of the illness not my direct action.
- Gilbert Meilaender puts it well: “The fact that we ought not aim at death for ourselves or another does not mean that we must always do everything possible to oppose it.” Thus, rejecting a treatment that is burdensome is not a refusal of life. But here the physician must be both careful and honest.
Instead of asking, “Is the patient’s life a benefit to him?” the physician should inquire “What, if anything, can we do that will benefit the life that he has?" Our task, writes Meilaender, “is not to judge the worth of this person’s life relative to other possible or actual lives. Our task is to care for the life he has as best we can.”
- Regarding morphine, we must again draw careful distinctions, this time between euthanasia and sufficient pain relief to dying patients. Put differently, Meilaender says we must distinguish between an act’s aim (intent) and its foreseen results. A patient in the final stages of terminal cancer may request increasingly large doses of morphine to control pain even though the increase might (though not necessarily) hasten death.
In this particular case, the intent of the physician is to relieve pain and provide the best care possible given the circumstances. True, he can foresee a possible result—death may come slightly sooner—but he does not intend that. He simply intends to relieve pain and make the patient as comfortable as possible. Thus, instead of intentionally killing the patient with a heavy overdose, he provides a carefully calibrated increase in morphine aimed at controlling pain, not bringing about a quicker death.
As Rae points out, “it’s acceptable for dying patients to sleep before they die.” Though death is foreseen, it is not intended. In the end, the patient dies from his underlying illness, not because the doctor intentionally kills him.
- To sum up, treatment can be removed when:
- A competent patient requests removal
- It no longer benefits the patient medically in the final stages of dying
- The burden outweighs benefit and only causes increased suffering
Gilbert Meilaender, Bioethics: A Primer for Christians (Grand Rapids: Eerdmans, 2005)
Scott Rae, Moral Choices: An Introduction to Ethics (Grand Rapids: Zondervan, 2009)
Wesley J. Smith, Culture of Death: The Assault on Medical Ethics in America (San Francisco; Encounter, 2000)
Leon Kass, Life, Liferty, and the Defense of Dignity (San Francisco: Encounter, 2002)
Nancy Pearcey, Love Thy Body: Answering Hard Questions About Life and Sexuality (Grand Rapids: Baker, 2018)
Mary Ann Glendon, Rights Talk: The Impoverishment of Political Discourse (New York: Free Press, 1991)
Christopher Kaczor, A Defense of Dignity: Creating Life, Destroying Life, and Protecting the Rights of Conscience (Notre Dame: University of Notre Dame Press, 2013)
John Kilner, et al, Why the Church Needs Bioethics: A Guide to Wise Engagement with Life’s Challenges (Grand Rapids: Zondervan, 2011)
Ira Byock, MD, The Best Care Possible: A Physician’s Quest to Transform Care Through the End of Life (New York: Penguin, 2013)
Agneta Sutton, Christian Bioethics: A Guide for the Perplexed (London: T&T Clark, 2008)
Blaise Alleyne & Jonathan Van Maren, A Guide to Discussing Assisted Suicide (Life Cycle Books, 2017)